Abstract
We prospectively studied an adolescent girl with insulin-dependent diabetes over a 22-month period. She initially presented with poor glycemie control and arrested pubertal development. Despite an immature luteinizing hormone (LH) secretory profile, she exhibited a mature LH response to injection of a bolus of synthetic gonado-tropin-releasing hormone (GnRH) at the time of initial evaluation. Improvement of her glycemic control was associated with maturation of LH pulsatility, improved estrogen production, and menarche. Subsequent deterioration of her glycemic control resulted in immaturity of pulsatile LH secretory pattern, whereas her response to GnRH remained mature. We hypothesize that the ovarian hypo-function observed was due to inhibition of the hypothalamic GnRH pulse generator and was influenced by the prevailing level of glycemia. In all cases, short-term glycemic control (as measured by fructosamine) was a better predictor of hormonal secretion than was long-term glycemic control (as measured by glycohemoglobin).
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